Healthcare Updates — 08-22-2011

Florida is back in the news again. After creating legislation to criminalize medicine, creating a three strikes law where doctors lose their license if they lose three malpractice suits, and having some of the highest malpractice premiums in the country, a funny thing seems to be happening. Florida doesn’t have enough doctors.Now Senator Bill Nelson from Florida came out with a press release stating that “Florida desperately needs more doctors” and describing how Florida is increasing the funding for residency training in the state in an attempt to increase the number of doctors in the state.
Without creating a better environment in which to practice medicine, most of the residents will leave once they finish their training.
Remember that whole “perfect care versus available care” dilemma? Why would doctors want to practice in Florida when there are states with much better practice environments?

New York is another state in which medical care is tanking. An Op Ed piece in the NY Post by the creator of health care reform in Texas shows some compelling facts. Nearly 1,300 physicians have left New York for Texas since 2003. The number of physicians in Texas has almost doubled since tort reform was enacted. Total amount for malpractice claims was eight times higher in NY than in Texas. Charity care in Texas is up by $500 million per year. After tort reform was enacted, Texas added more than 2 million patient visits per year.
Perfect care or available care?

What specialties get sued the most? You probably knew the answer – neurosurgery, cardiovascular surgery, and general surgery. By age 65, 99% of physicians in these specialties have been sued. Emergency physicians are sued just a bit more than the average for all physicians. Pediatricians paid out the most per claim, on average forking over $520,000. And only 1 in 5 cases leads to a settlement or other payout. That must mean that 80% of the filed medical malpractice cases are frivolous, right?. Read more findings in this NEJM study.

Sprained ankles straining resources in the emergency department? An article in Clinical Orthopedics says so. The authors want patients with lower extremity injuries to call an emergency phone number to get a visit with a doctor during regular business hours. Is the study another way of saying that emergency departments are taking a bite out of some orthopedists’ bottom lines?

What types of cases come through the emergency department at night in Sydney, Australia? Read this article to find out. Hard to believe that wearing the color black has to do with any of the injuries, though.

Contrast the Carlisle case with the situation in Canada. This article notes that overcrowding in Canada results in many who need to be admitted waiting on stretchers for up to two days. Most patients are seen by a doctor in 24 hours, though. I think that Pennsylvania’s Health Department would go into convulsions in Canada.

When I broke my finger I did an urgent care trip to get it splinted and then an orthopedic hand surgeon follow up a couple days later. No emergency room needed, and certainly not 2 weeks for treatment.

Yea, that’s true if you can’t actually walk. I’m not doubting you- I’ve had a severe sprain where I couldn’t bear weight for a couple of days. It does happen. BUT, at least 95% of our patients limp through the door (or sometimes walk perfectly normally), complaining that it hurts to walk. If you can walk, it can normally wait.

NEJM proves the tort system is one of the best lotteries out there. At least for lawyers. I’d take those 1 in 6 odds for a $30,000 jackpot (assuming you’re in a state that limits attorney fee to 30% of the first 100,000). And that’s just the median. Unfortunately, those aren’t great odds if you happen to actually be one of those clients. Or the premium-paying hospital funding the whole operation.

For the 5.2 million for the 37 year old pharmacist misdiagnosed by his family doctor…I think the plaintiffs have a solid argument for not meeting standard of care there. Obviously I haven’t read the entire transcript and I don’t know the details but with every chest pain referral that we get from a PCP office- I didn’t know they were sending ANYONE home with chest pain without sending them to the ED. I am sure that the PCPs out there will argue that, just like we do, that they send home a lot of chest pain/abdominal pain without mega workups but someone with chest pain radiating up to his jaw with those risk factors? Slam dunk admit and they can send that my way any day of the week.

Also- the initial jury verdict of 4 million was actually reasonable for once if you consider his salary and his age. He was 37, so if you round up and say he would work for 30 more years with an average salary of 100K (google search for retail pharmacy average salaries)- then that is 3 million right there. I’m from PA and Berks county is a pretty nice area so he probably made more than that. I don’t know what’s up with the extra 1 million for the delay in the case. My point being that for once, it looks like an award matched up with the actual damages.